|
EAR DRESSING GLASSCOCK ADULT S-1000
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
3204818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$195.31
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
EAR DRESSING GLASSCOCK ADULT S-1000
|
Facility
|
OP
|
$313.00
|
|
| Hospital Charge Code |
3204818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.15 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Aetna Managed Medicare |
$91.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$211.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.17
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.14
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: NAPHCARE Commercial |
$195.31
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$211.59
|
| Rate for Payer: Quartz Medicare Advantage |
$195.31
|
| Rate for Payer: The Alliance Commercial |
$162.76
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
EAR EXAM WITH ANESTHESIA
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
EAR EXAM WITH ANESTHESIA
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Early Sjogren's Syndrome Profile
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.19 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$207.17
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Early Sjogren's Syndrome Profile
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$328.02 |
| Rate for Payer: Aetna Commercial |
$328.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$328.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$314.20
|
| Rate for Payer: HFN Commercial |
$328.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$328.02
|
| Rate for Payer: Quartz Beloit One Network |
$151.92
|
| Rate for Payer: Quartz Commercial |
$196.81
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Early Sjogren's Syndrome Profile
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$224.43
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Ear Mold/Insert
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Ear Mold/Insert
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.89
|
| Rate for Payer: Health EOS Commercial |
$106.00
|
| Rate for Payer: HFN Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$110.66
|
| Rate for Payer: Quartz Beloit One Network |
$51.25
|
| Rate for Payer: Quartz Commercial |
$66.39
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Ear Mold/Insert
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$32.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$69.89
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: United Healthcare PPO |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Ear Mold/Insert, Disp
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.86
|
| Rate for Payer: Health EOS Commercial |
$17.98
|
| Rate for Payer: HFN Commercial |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Preferred Network Access Commercial |
$18.77
|
| Rate for Payer: Quartz Beloit One Network |
$8.69
|
| Rate for Payer: Quartz Commercial |
$11.26
|
| Rate for Payer: The Alliance Commercial |
$9.88
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
Ear Mold/Insert, Disp
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| 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
|
|
|
Ear Mold/Insert, Disp
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| 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: United Healthcare PPO |
$14.82
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$34,502.00
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$10,244.19 |
| Max. Negotiated Rate |
$34,502.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,244.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,743.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,264.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,203.02
|
| Rate for Payer: Anthem Medicare Advantage |
$10,244.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,244.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,244.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,244.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,427.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,244.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,062.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,244.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,244.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,244.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,244.19
|
| Rate for Payer: NAPHCARE Commercial |
$15,366.28
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.19
|
| Rate for Payer: The Alliance Commercial |
$34,502.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,244.19
|
| Rate for Payer: United Healthcare PPO |
$19,511.11
|
| Rate for Payer: Wellcare Medicare |
$10,244.19
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$58,700.72
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$16,722.25 |
| Max. Negotiated Rate |
$58,700.72 |
| Rate for Payer: Aetna Managed Medicare |
$16,722.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,199.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,411.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,643.62
|
| Rate for Payer: Anthem Medicare Advantage |
$16,722.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,722.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,722.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,722.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,347.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,722.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,811.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,722.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,722.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,722.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,722.25
|
| Rate for Payer: NAPHCARE Commercial |
$25,083.38
|
| Rate for Payer: Quartz Medicare Advantage |
$16,722.25
|
| Rate for Payer: The Alliance Commercial |
$58,700.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,722.25
|
| Rate for Payer: United Healthcare PPO |
$33,328.97
|
| Rate for Payer: Wellcare Medicare |
$16,722.25
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$24,932.96
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$6,611.12 |
| Max. Negotiated Rate |
$24,932.96 |
| Rate for Payer: Aetna Managed Medicare |
$6,611.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,392.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,330.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,665.22
|
| Rate for Payer: Anthem Medicare Advantage |
$6,611.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,611.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,611.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,611.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,059.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,611.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,043.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,611.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,611.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,611.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,611.12
|
| Rate for Payer: NAPHCARE Commercial |
$9,916.69
|
| Rate for Payer: Quartz Medicare Advantage |
$6,611.12
|
| Rate for Payer: The Alliance Commercial |
$24,932.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,611.12
|
| Rate for Payer: United Healthcare PPO |
$14,046.80
|
| Rate for Payer: Wellcare Medicare |
$6,611.12
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$12,801.73
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$11,371.30 |
| Max. Negotiated Rate |
$12,801.73 |
| Rate for Payer: Anthem Medicaid |
$12,258.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,258.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,258.36
|
| Rate for Payer: Dean Health Medicaid |
$12,258.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,371.30
|
| Rate for Payer: Managed Health Services Medicaid |
$12,801.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,258.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,258.36
|
| Rate for Payer: United Healthcare Medicaid |
$12,258.36
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$9,294.41
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$8,255.87 |
| Max. Negotiated Rate |
$9,294.41 |
| Rate for Payer: Anthem Medicaid |
$8,899.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,899.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,899.91
|
| Rate for Payer: Dean Health Medicaid |
$8,899.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,255.87
|
| Rate for Payer: Managed Health Services Medicaid |
$9,294.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,899.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,899.91
|
| Rate for Payer: United Healthcare Medicaid |
$8,899.91
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$21,920.78
|
|
|
Service Code
|
APR-DRG 1104
|
| Min. Negotiated Rate |
$19,471.40 |
| Max. Negotiated Rate |
$21,920.78 |
| Rate for Payer: Anthem Medicaid |
$20,990.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,990.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,990.35
|
| Rate for Payer: Dean Health Medicaid |
$20,990.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,471.40
|
| Rate for Payer: Managed Health Services Medicaid |
$21,920.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,990.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,990.35
|
| Rate for Payer: United Healthcare Medicaid |
$20,990.35
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$8,154.53
|
|
|
Service Code
|
APR-DRG 1101
|
| Min. Negotiated Rate |
$7,243.36 |
| Max. Negotiated Rate |
$8,154.53 |
| Rate for Payer: Anthem Medicaid |
$7,808.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,808.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,808.41
|
| Rate for Payer: Dean Health Medicaid |
$7,808.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,243.36
|
| Rate for Payer: Managed Health Services Medicaid |
$8,154.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,808.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,808.41
|
| Rate for Payer: United Healthcare Medicaid |
$7,808.41
|
|
|
EAR, NOSE, MOUTH, THROAT, CRANIAL AND FACIAL MALIGNANCIES
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00560
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
East Equine IgG
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
East Equine IgG
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
East Equine IgG
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| 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 |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| 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 |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
East Equine IgM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
