|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$22,008.46
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$19,549.29 |
| Max. Negotiated Rate |
$22,008.46 |
| Rate for Payer: Anthem Medicaid |
$21,074.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,074.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,074.31
|
| Rate for Payer: Dean Health Medicaid |
$21,074.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,549.29
|
| Rate for Payer: Managed Health Services Medicaid |
$22,008.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,074.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,074.31
|
| Rate for Payer: United Healthcare Medicaid |
$21,074.31
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00842
|
| 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
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$4,559.52
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$4,050.05 |
| Max. Negotiated Rate |
$4,559.52 |
| Rate for Payer: Anthem Medicaid |
$4,365.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,365.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,365.99
|
| Rate for Payer: Dean Health Medicaid |
$4,365.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,050.05
|
| Rate for Payer: Managed Health Services Medicaid |
$4,559.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,365.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,365.99
|
| Rate for Payer: United Healthcare Medicaid |
$4,365.99
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$19,202.60
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$17,056.95 |
| Max. Negotiated Rate |
$19,202.60 |
| Rate for Payer: Anthem Medicaid |
$18,387.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,387.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,387.55
|
| Rate for Payer: Dean Health Medicaid |
$18,387.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,056.95
|
| Rate for Payer: Managed Health Services Medicaid |
$19,202.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,387.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,387.55
|
| Rate for Payer: United Healthcare Medicaid |
$18,387.55
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$16,217.76
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$5,231.12 |
| Max. Negotiated Rate |
$16,217.76 |
| Rate for Payer: Aetna Managed Medicare |
$5,231.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,460.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,317.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,802.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,231.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,231.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,231.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,231.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,881.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,231.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,231.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,231.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,231.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,231.12
|
| Rate for Payer: NAPHCARE Commercial |
$7,846.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,231.12
|
| Rate for Payer: The Alliance Commercial |
$16,217.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,231.12
|
| Rate for Payer: United Healthcare PPO |
$9,070.34
|
| Rate for Payer: Wellcare Medicare |
$5,231.12
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$49,496.72
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$13,871.09 |
| Max. Negotiated Rate |
$49,496.72 |
| Rate for Payer: Aetna Managed Medicare |
$13,871.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,076.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,185.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,728.10
|
| Rate for Payer: Anthem Medicare Advantage |
$13,871.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,871.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,871.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,871.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,780.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,871.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,871.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,871.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,871.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,871.09
|
| Rate for Payer: NAPHCARE Commercial |
$20,806.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13,871.09
|
| Rate for Payer: The Alliance Commercial |
$49,496.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,871.09
|
| Rate for Payer: United Healthcare PPO |
$28,073.07
|
| Rate for Payer: Wellcare Medicare |
$13,871.09
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$23,989.68
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$7,267.44 |
| Max. Negotiated Rate |
$23,989.68 |
| Rate for Payer: Aetna Managed Medicare |
$7,267.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,261.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,764.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,026.92
|
| Rate for Payer: Anthem Medicare Advantage |
$7,267.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,267.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,267.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,267.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,571.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,267.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,267.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,267.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,267.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,267.44
|
| Rate for Payer: NAPHCARE Commercial |
$10,901.16
|
| Rate for Payer: Quartz Medicare Advantage |
$7,267.44
|
| Rate for Payer: The Alliance Commercial |
$23,989.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,267.44
|
| Rate for Payer: United Healthcare PPO |
$13,508.41
|
| Rate for Payer: Wellcare Medicare |
$7,267.44
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$44,815.68
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$11,347.72 |
| Max. Negotiated Rate |
$44,815.68 |
| Rate for Payer: Aetna Managed Medicare |
$11,347.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,887.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,674.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,492.64
|
| Rate for Payer: Anthem Medicare Advantage |
$11,347.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,347.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,347.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,347.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,968.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,347.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,347.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,347.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,347.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,347.72
|
| Rate for Payer: NAPHCARE Commercial |
$17,021.58
|
| Rate for Payer: Quartz Medicare Advantage |
$11,347.72
|
| Rate for Payer: The Alliance Commercial |
$44,815.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,347.72
|
| Rate for Payer: United Healthcare PPO |
$25,400.12
|
| Rate for Payer: Wellcare Medicare |
$11,347.72
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00633
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$22,709.92
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$20,172.37 |
| Max. Negotiated Rate |
$22,709.92 |
| Rate for Payer: Anthem Medicaid |
$21,746.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,746.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,746.00
|
| Rate for Payer: Dean Health Medicaid |
$21,746.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,172.37
|
| Rate for Payer: Managed Health Services Medicaid |
$22,709.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,746.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,746.00
|
| Rate for Payer: United Healthcare Medicaid |
$21,746.00
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$5,524.04
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$4,906.79 |
| Max. Negotiated Rate |
$5,524.04 |
| Rate for Payer: Anthem Medicaid |
$5,289.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,289.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,289.57
|
| Rate for Payer: Dean Health Medicaid |
$5,289.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,906.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5,524.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,289.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,289.57
|
| Rate for Payer: United Healthcare Medicaid |
$5,289.57
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$10,280.90 |
| Max. Negotiated Rate |
$11,574.17 |
| Rate for Payer: Anthem Medicaid |
$11,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,082.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,082.90
|
| Rate for Payer: Dean Health Medicaid |
$11,082.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,280.90
|
| Rate for Payer: Managed Health Services Medicaid |
$11,574.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,082.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,082.90
|
| Rate for Payer: United Healthcare Medicaid |
$11,082.90
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$7,365.38
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$6,542.39 |
| Max. Negotiated Rate |
$7,365.38 |
| Rate for Payer: Anthem Medicaid |
$7,052.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,052.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,052.76
|
| Rate for Payer: Dean Health Medicaid |
$7,052.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,542.39
|
| Rate for Payer: Managed Health Services Medicaid |
$7,365.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,052.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,052.76
|
| Rate for Payer: United Healthcare Medicaid |
$7,052.76
|
|
|
Alcohol Isopropyl 16oz [Med]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS A4244
|
| Hospital Charge Code |
2974906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.06
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$11.86
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.84
|
| Rate for Payer: Quartz Medicare Advantage |
$11.86
|
| Rate for Payer: The Alliance Commercial |
$9.88
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
Alcohol Isopropyl 16oz [Med]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS A4244
|
| Hospital Charge Code |
2974906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
Alcohol, Isopropyl, Blood
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$34.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$74.88
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: United Healthcare PPO |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Alcohol, Isopropyl, Blood
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.91 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.88
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Alcohol, Isopropyl, Blood
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Alcohol, Methyl, Blood
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Aetna Managed Medicare |
$41.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.06
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.98
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: NAPHCARE Commercial |
$87.98
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$95.32
|
| Rate for Payer: Quartz Medicare Advantage |
$87.98
|
| Rate for Payer: The Alliance Commercial |
$73.32
|
| Rate for Payer: United Healthcare PPO |
$109.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Alcohol, Methyl, Blood
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$87.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Alcohol, Methyl, Blood
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$139.31 |
| Rate for Payer: Aetna Commercial |
$139.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$139.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.98
|
| Rate for Payer: Health EOS Commercial |
$133.44
|
| Rate for Payer: HFN Commercial |
$139.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$139.31
|
| Rate for Payer: Quartz Beloit One Network |
$64.52
|
| Rate for Payer: Quartz Commercial |
$83.58
|
| Rate for Payer: The Alliance Commercial |
$73.32
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
ALCO-SCREEN ALCOHOL TESTING 55001-25
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2970143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
ALCO-SCREEN ALCOHOL TESTING 55001-25
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2970143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
