|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$67,601.04
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$19,827.65 |
| Max. Negotiated Rate |
$67,601.04 |
| Rate for Payer: Aetna Managed Medicare |
$19,827.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55,047.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42,193.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,086.66
|
| Rate for Payer: Anthem Medicare Advantage |
$19,827.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,827.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,827.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,827.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44,499.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,827.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,339.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,827.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,827.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,827.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,827.65
|
| Rate for Payer: NAPHCARE Commercial |
$29,741.48
|
| Rate for Payer: Quartz Medicare Advantage |
$19,827.65
|
| Rate for Payer: The Alliance Commercial |
$67,601.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,827.65
|
| Rate for Payer: United Healthcare PPO |
$38,411.20
|
| Rate for Payer: Wellcare Medicare |
$19,827.65
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$168,723.36
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$52,054.87 |
| Max. Negotiated Rate |
$168,723.36 |
| Rate for Payer: Aetna Managed Medicare |
$52,054.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146,867.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112,572.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106,951.26
|
| Rate for Payer: Anthem Medicare Advantage |
$52,054.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52,054.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52,054.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$52,054.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118,725.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$52,054.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123,509.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52,054.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52,054.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$52,054.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$52,054.87
|
| Rate for Payer: NAPHCARE Commercial |
$78,082.31
|
| Rate for Payer: Quartz Medicare Advantage |
$52,054.87
|
| Rate for Payer: The Alliance Commercial |
$168,723.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52,054.87
|
| Rate for Payer: United Healthcare PPO |
$96,153.54
|
| Rate for Payer: Wellcare Medicare |
$52,054.87
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$23,411.39
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$20,795.46 |
| Max. Negotiated Rate |
$23,411.39 |
| Rate for Payer: Anthem Medicaid |
$22,417.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,417.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,417.69
|
| Rate for Payer: Dean Health Medicaid |
$22,417.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,795.46
|
| Rate for Payer: Managed Health Services Medicaid |
$23,411.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,417.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,417.69
|
| Rate for Payer: United Healthcare Medicaid |
$22,417.69
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$21,833.09
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$19,393.51 |
| Max. Negotiated Rate |
$21,833.09 |
| Rate for Payer: Anthem Medicaid |
$20,906.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,906.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,906.39
|
| Rate for Payer: Dean Health Medicaid |
$20,906.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,393.51
|
| Rate for Payer: Managed Health Services Medicaid |
$21,833.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,906.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,906.39
|
| Rate for Payer: United Healthcare Medicaid |
$20,906.39
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$38,492.88
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$34,191.78 |
| Max. Negotiated Rate |
$38,492.88 |
| Rate for Payer: Anthem Medicaid |
$36,859.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,859.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,859.05
|
| Rate for Payer: Dean Health Medicaid |
$36,859.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,191.78
|
| Rate for Payer: Managed Health Services Medicaid |
$38,492.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,859.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,859.05
|
| Rate for Payer: United Healthcare Medicaid |
$36,859.05
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$59,624.51
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$52,962.21 |
| Max. Negotiated Rate |
$59,624.51 |
| Rate for Payer: Anthem Medicaid |
$57,093.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$57,093.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57,093.75
|
| Rate for Payer: Dean Health Medicaid |
$57,093.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52,962.21
|
| Rate for Payer: Managed Health Services Medicaid |
$59,624.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$57,093.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$57,093.75
|
| Rate for Payer: United Healthcare Medicaid |
$57,093.75
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$157,072.24
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$44,390.54 |
| Max. Negotiated Rate |
$157,072.24 |
| Rate for Payer: Aetna Managed Medicare |
$44,390.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95,834.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91,049.42
|
| Rate for Payer: Anthem Medicare Advantage |
$44,390.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,390.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,390.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,390.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101,073.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,390.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114,963.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,390.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,390.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,390.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,390.54
|
| Rate for Payer: NAPHCARE Commercial |
$66,585.81
|
| Rate for Payer: Quartz Medicare Advantage |
$44,390.54
|
| Rate for Payer: The Alliance Commercial |
$157,072.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,390.54
|
| Rate for Payer: United Healthcare PPO |
$89,500.37
|
| Rate for Payer: Wellcare Medicare |
$44,390.54
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$105,090.96
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$30,464.89 |
| Max. Negotiated Rate |
$105,090.96 |
| Rate for Payer: Aetna Managed Medicare |
$30,464.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85,354.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65,423.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62,156.65
|
| Rate for Payer: Anthem Medicare Advantage |
$30,464.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,464.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,464.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,464.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68,999.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,464.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76,836.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,464.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,464.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,464.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,464.89
|
| Rate for Payer: NAPHCARE Commercial |
$45,697.33
|
| Rate for Payer: Quartz Medicare Advantage |
$30,464.89
|
| Rate for Payer: The Alliance Commercial |
$105,090.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,464.89
|
| Rate for Payer: United Healthcare PPO |
$59,818.48
|
| Rate for Payer: Wellcare Medicare |
$30,464.89
|
|
|
C-Reactive Protein
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
633716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
C-Reactive Protein
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
633716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
C-Reactive Protein
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
633716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
C-Reactive Protein High Sensitivity
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
977885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$13.47
|
| Rate for Payer: Anthem Medicare Advantage |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.47
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.47
|
| Rate for Payer: Health EOS Commercial |
$196.85
|
| Rate for Payer: HFN Commercial |
$205.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.47
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$20.20
|
| Rate for Payer: Preferred Network Access Commercial |
$205.50
|
| Rate for Payer: Quartz Beloit One Network |
$95.18
|
| Rate for Payer: Quartz Commercial |
$123.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.47
|
| Rate for Payer: The Alliance Commercial |
$53.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.47
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
C-Reactive Protein High Sensitivity
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
977885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
C-Reactive Protein High Sensitivity
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
977885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$13.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.36
|
| Rate for Payer: Anthem Medicare Advantage |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.47
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.47
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.47
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$20.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$140.61
|
| Rate for Payer: Quartz Medicare Advantage |
$13.47
|
| Rate for Payer: The Alliance Commercial |
$53.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.47
|
| Rate for Payer: United Healthcare PPO |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: Wellcare Medicare |
$13.47
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
C-REAMER 9MM 8772A
|
Facility
|
IP
|
$1,575.00
|
|
| Hospital Charge Code |
2964907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
C-REAMER 9MM 8772A
|
Facility
|
OP
|
$1,575.00
|
|
| Hospital Charge Code |
2964907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.64 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$458.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.65
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.50
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$982.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$1,064.70
|
| Rate for Payer: Quartz Medicare Advantage |
$982.80
|
| Rate for Payer: The Alliance Commercial |
$819.00
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
CREAM FREE UP MASSAGE 8OZ #8319
|
Facility
|
OP
|
$232.00
|
|
| Hospital Charge Code |
2974048
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.56 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$67.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.02
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.96
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$156.83
|
| Rate for Payer: Quartz Medicare Advantage |
$144.77
|
| Rate for Payer: The Alliance Commercial |
$120.64
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
CREAM FREE UP MASSAGE 8OZ #8319
|
Facility
|
IP
|
$232.00
|
|
| Hospital Charge Code |
2974048
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$144.77
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
CREAM MASSAGE BIOTONE 1 GAL #5583-82
|
Facility
|
IP
|
$1,192.00
|
|
| Hospital Charge Code |
2969735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$607.44 |
| Max. Negotiated Rate |
$1,140.51 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,140.51
|
| Rate for Payer: Health EOS Commercial |
$1,103.32
|
| Rate for Payer: HFN Commercial |
$1,140.51
|
| Rate for Payer: Multiplan Commercial |
$991.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.51
|
| Rate for Payer: Quartz Beloit One Network |
$607.44
|
| Rate for Payer: Quartz Commercial |
$743.81
|
| Rate for Payer: WEA Trust Commercial |
$681.82
|
| Rate for Payer: WPS Commercial |
$918.20
|
|
|
CREAM MASSAGE BIOTONE 1 GAL #5583-82
|
Facility
|
OP
|
$1,192.00
|
|
| Hospital Charge Code |
2969735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$1,140.51 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$805.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$595.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,140.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.74
|
| Rate for Payer: Health EOS Commercial |
$1,103.32
|
| Rate for Payer: HFN Commercial |
$1,140.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$929.76
|
| Rate for Payer: Multiplan Commercial |
$991.74
|
| Rate for Payer: NAPHCARE Commercial |
$743.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.51
|
| Rate for Payer: Quartz Beloit One Network |
$607.44
|
| Rate for Payer: Quartz Commercial |
$805.79
|
| Rate for Payer: Quartz Medicare Advantage |
$743.81
|
| Rate for Payer: The Alliance Commercial |
$619.84
|
| Rate for Payer: WEA Trust Commercial |
$681.82
|
| Rate for Payer: WPS Commercial |
$918.20
|
|
|
CREAM SENSICARE SKIN 4 OZ **SUB FOR 2100314**
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
2963316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$41.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$89.86
|
| Rate for Payer: The Alliance Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
CREAM SENSICARE SKIN 4 OZ **SUB FOR 2100314**
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
2963316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
CREAM SHAVING 1.5oz
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2963222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
CREAM SHAVING 1.5oz
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2963222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Create Eardrum Opening 6943350
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
CPT 69433 50
|
| Hospital Charge Code |
3975035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$1,599.57 |
| Rate for Payer: Aetna Commercial |
$1,599.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,599.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.26
|
| Rate for Payer: Health EOS Commercial |
$1,532.22
|
| Rate for Payer: HFN Commercial |
$1,599.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.05
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.57
|
| Rate for Payer: Quartz Beloit One Network |
$740.85
|
| Rate for Payer: Quartz Commercial |
$959.74
|
| Rate for Payer: The Alliance Commercial |
$841.88
|
| Rate for Payer: United Healthcare Medicaid |
$171.68
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
