|
EAPG 875: CONTRACEPTIVE MANAGEMENT
|
Facility
|
OP
|
$118.40
|
|
|
Service Code
|
EAPG 00875
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Anthem Medicaid |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$118.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.98
|
| Rate for Payer: Dean Health Medicaid |
$68.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$68.98
|
| Rate for Payer: Managed Health Services Medicaid |
$71.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$68.98
|
| Rate for Payer: United Healthcare Medicaid |
$68.98
|
| Rate for Payer: WMAP Medicaid |
$68.98
|
|
|
EAPG 876: ADULT PREVENTIVE MEDICINE
|
Facility
|
OP
|
$120.50
|
|
|
Service Code
|
EAPG 00876
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Anthem Medicaid |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$120.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.47
|
| Rate for Payer: Dean Health Medicaid |
$62.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$62.47
|
| Rate for Payer: Managed Health Services Medicaid |
$64.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$62.47
|
| Rate for Payer: United Healthcare Medicaid |
$62.47
|
| Rate for Payer: WMAP Medicaid |
$62.47
|
|
|
EAPG 877: CHILD PREVENTIVE MEDICINE
|
Facility
|
OP
|
$96.28
|
|
|
Service Code
|
EAPG 00877
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$96.28 |
| Rate for Payer: Anthem Medicaid |
$54.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$96.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.27
|
| Rate for Payer: Dean Health Medicaid |
$54.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$54.27
|
| Rate for Payer: Managed Health Services Medicaid |
$56.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$54.27
|
| Rate for Payer: United Healthcare Medicaid |
$54.27
|
| Rate for Payer: WMAP Medicaid |
$54.27
|
|
|
EAPG 878: GYNECOLOGIC PREVENTIVE MEDICINE
|
Facility
|
OP
|
$100.73
|
|
|
Service Code
|
EAPG 00878
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$100.73 |
| Rate for Payer: Anthem Medicaid |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.30
|
| Rate for Payer: Dean Health Medicaid |
$46.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46.30
|
| Rate for Payer: Managed Health Services Medicaid |
$48.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46.30
|
| Rate for Payer: United Healthcare Medicaid |
$46.30
|
| Rate for Payer: WMAP Medicaid |
$46.30
|
|
|
EAPG 879: PREVENTIVE OR SCREENING ENCOUNTER
|
Facility
|
OP
|
$111.69
|
|
|
Service Code
|
EAPG 00879
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$111.69 |
| Rate for Payer: Anthem Medicaid |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$111.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.56
|
| Rate for Payer: Dean Health Medicaid |
$63.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.56
|
| Rate for Payer: Managed Health Services Medicaid |
$66.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.56
|
| Rate for Payer: United Healthcare Medicaid |
$63.56
|
| Rate for Payer: WMAP Medicaid |
$63.56
|
|
|
EAPG 87: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES
|
Facility
|
OP
|
$4,601.50
|
|
|
Service Code
|
EAPG 00087
|
| Min. Negotiated Rate |
$3,002.17 |
| Max. Negotiated Rate |
$4,601.50 |
| Rate for Payer: Anthem Medicaid |
$3,002.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,601.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,002.17
|
| Rate for Payer: Dean Health Medicaid |
$3,002.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,002.17
|
| Rate for Payer: Managed Health Services Medicaid |
$3,122.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,601.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,002.17
|
| Rate for Payer: United Healthcare Medicaid |
$3,002.17
|
| Rate for Payer: WMAP Medicaid |
$3,002.17
|
|
|
EAPG 880: HIV INFECTION
|
Facility
|
OP
|
$123.53
|
|
|
Service Code
|
EAPG 00880
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$123.53 |
| Rate for Payer: Anthem Medicaid |
$98.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$123.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.51
|
| Rate for Payer: Dean Health Medicaid |
$98.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.51
|
| Rate for Payer: Managed Health Services Medicaid |
$102.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.51
|
| Rate for Payer: United Healthcare Medicaid |
$98.51
|
| Rate for Payer: WMAP Medicaid |
$98.51
|
|
|
EAPG 881: AIDS
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
EAPG 00881
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Anthem Medicaid |
$100.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$136.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.96
|
| Rate for Payer: Dean Health Medicaid |
$100.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.96
|
| Rate for Payer: Managed Health Services Medicaid |
$105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.96
|
| Rate for Payer: United Healthcare Medicaid |
$100.96
|
| Rate for Payer: WMAP Medicaid |
$100.96
|
|
|
EAPG 882: GENETIC COUNSELING
|
Facility
|
OP
|
$150.49
|
|
|
Service Code
|
EAPG 00882
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$150.49 |
| Rate for Payer: Anthem Medicaid |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$150.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.69
|
| Rate for Payer: Dean Health Medicaid |
$65.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$65.69
|
| Rate for Payer: Managed Health Services Medicaid |
$68.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$65.69
|
| Rate for Payer: United Healthcare Medicaid |
$65.69
|
| Rate for Payer: WMAP Medicaid |
$65.69
|
|
|
EAPG 883: ALTERATION IN CONSCIOUSNESS
|
Facility
|
OP
|
$137.81
|
|
|
Service Code
|
EAPG 00883
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Anthem Medicaid |
$132.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.51
|
| Rate for Payer: Dean Health Medicaid |
$132.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.51
|
| Rate for Payer: Managed Health Services Medicaid |
$137.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.51
|
| Rate for Payer: United Healthcare Medicaid |
$132.51
|
| Rate for Payer: WMAP Medicaid |
$132.51
|
|
|
EAPG 900: AUTOPSY AND POST-MORTEM EXAMINATION SERVICES
|
Facility
|
OP
|
$50.55
|
|
|
Service Code
|
EAPG 00900
|
| Min. Negotiated Rate |
$48.61 |
| Max. Negotiated Rate |
$50.55 |
| Rate for Payer: Anthem Medicaid |
$48.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.61
|
| Rate for Payer: Dean Health Medicaid |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.61
|
| Rate for Payer: Managed Health Services Medicaid |
$50.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.61
|
| Rate for Payer: United Healthcare Medicaid |
$48.61
|
| Rate for Payer: WMAP Medicaid |
$48.61
|
|
|
EAPG 90: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES
|
Facility
|
OP
|
$693.60
|
|
|
Service Code
|
EAPG 00090
|
| Min. Negotiated Rate |
$263.87 |
| Max. Negotiated Rate |
$693.60 |
| Rate for Payer: Anthem Medicaid |
$263.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$693.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.87
|
| Rate for Payer: Dean Health Medicaid |
$263.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$263.87
|
| Rate for Payer: Managed Health Services Medicaid |
$274.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$263.87
|
| Rate for Payer: United Healthcare Medicaid |
$263.87
|
| Rate for Payer: WMAP Medicaid |
$263.87
|
|
|
EAPG 91: LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
|
OP
|
$1,906.27
|
|
|
Service Code
|
EAPG 00091
|
| Min. Negotiated Rate |
$1,660.32 |
| Max. Negotiated Rate |
$1,906.27 |
| Rate for Payer: Anthem Medicaid |
$1,660.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,906.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,660.32
|
| Rate for Payer: Dean Health Medicaid |
$1,660.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,660.32
|
| Rate for Payer: Managed Health Services Medicaid |
$1,726.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,906.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,660.32
|
| Rate for Payer: United Healthcare Medicaid |
$1,660.32
|
| Rate for Payer: WMAP Medicaid |
$1,660.32
|
|
|
EAPG 92: RESUSCITATION
|
Facility
|
OP
|
$533.81
|
|
|
Service Code
|
EAPG 00092
|
| Min. Negotiated Rate |
$292.05 |
| Max. Negotiated Rate |
$533.81 |
| Rate for Payer: Anthem Medicaid |
$292.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$533.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.05
|
| Rate for Payer: Dean Health Medicaid |
$292.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$292.05
|
| Rate for Payer: Managed Health Services Medicaid |
$303.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$292.05
|
| Rate for Payer: United Healthcare Medicaid |
$292.05
|
| Rate for Payer: WMAP Medicaid |
$292.05
|
|
|
EAPG 93: CARDIOVERSION
|
Facility
|
OP
|
$481.51
|
|
|
Service Code
|
EAPG 00093
|
| Min. Negotiated Rate |
$257.48 |
| Max. Negotiated Rate |
$481.51 |
| Rate for Payer: Anthem Medicaid |
$257.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$481.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.48
|
| Rate for Payer: Dean Health Medicaid |
$257.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$257.48
|
| Rate for Payer: Managed Health Services Medicaid |
$267.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$481.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$257.48
|
| Rate for Payer: United Healthcare Medicaid |
$257.48
|
| Rate for Payer: WMAP Medicaid |
$257.48
|
|
|
EAPG 94: CARDIAC REHABILITATION
|
Facility
|
OP
|
$380.87
|
|
|
Service Code
|
EAPG 00094
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$380.87 |
| Rate for Payer: Anthem Medicaid |
$64.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$380.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.84
|
| Rate for Payer: Dean Health Medicaid |
$64.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.84
|
| Rate for Payer: Managed Health Services Medicaid |
$67.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.84
|
| Rate for Payer: United Healthcare Medicaid |
$64.84
|
| Rate for Payer: WMAP Medicaid |
$64.84
|
|
|
EAPG 96: CARDIAC ELECTROPHYSIOLOGIC PROCEDURES INCLUDING PACING AND RECORDING
|
Facility
|
OP
|
$4,127.33
|
|
|
Service Code
|
EAPG 00096
|
| Min. Negotiated Rate |
$2,647.19 |
| Max. Negotiated Rate |
$4,127.33 |
| Rate for Payer: Anthem Medicaid |
$2,647.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,127.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,647.19
|
| Rate for Payer: Dean Health Medicaid |
$2,647.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,647.19
|
| Rate for Payer: Managed Health Services Medicaid |
$2,753.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,127.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,647.19
|
| Rate for Payer: United Healthcare Medicaid |
$2,647.19
|
| Rate for Payer: WMAP Medicaid |
$2,647.19
|
|
|
EAPG 97: AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT
|
Facility
|
OP
|
$18,236.47
|
|
|
Service Code
|
EAPG 00097
|
| Min. Negotiated Rate |
$9,209.36 |
| Max. Negotiated Rate |
$18,236.47 |
| Rate for Payer: Anthem Medicaid |
$9,209.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,236.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,209.36
|
| Rate for Payer: Dean Health Medicaid |
$9,209.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,209.36
|
| Rate for Payer: Managed Health Services Medicaid |
$9,577.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,236.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,209.36
|
| Rate for Payer: United Healthcare Medicaid |
$9,209.36
|
| Rate for Payer: WMAP Medicaid |
$9,209.36
|
|
|
EAPG 99: LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES
|
Facility
|
OP
|
$6,795.49
|
|
|
Service Code
|
EAPG 00099
|
| Min. Negotiated Rate |
$3,407.35 |
| Max. Negotiated Rate |
$6,795.49 |
| Rate for Payer: Anthem Medicaid |
$3,407.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,795.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,407.35
|
| Rate for Payer: Dean Health Medicaid |
$3,407.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,407.35
|
| Rate for Payer: Managed Health Services Medicaid |
$3,543.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,795.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,407.35
|
| Rate for Payer: United Healthcare Medicaid |
$3,407.35
|
| Rate for Payer: WMAP Medicaid |
$3,407.35
|
|
|
EAPG 9: LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
|
OP
|
$509.30
|
|
|
Service Code
|
EAPG 00009
|
| Min. Negotiated Rate |
$174.70 |
| Max. Negotiated Rate |
$509.30 |
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$509.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.70
|
| Rate for Payer: Dean Health Medicaid |
$174.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$174.70
|
| Rate for Payer: Managed Health Services Medicaid |
$181.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$509.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$174.70
|
| Rate for Payer: United Healthcare Medicaid |
$174.70
|
| Rate for Payer: WMAP Medicaid |
$174.70
|
|
|
EAR AND THROAT EXAMINATION 92502
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
3015328
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$319.61 |
| Max. Negotiated Rate |
$734.35 |
| Rate for Payer: Aetna Commercial |
$734.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.78
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$734.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.80
|
| Rate for Payer: Health EOS Commercial |
$703.43
|
| Rate for Payer: HFN Commercial |
$734.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$319.61
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$734.35
|
| Rate for Payer: Quartz Beloit One Network |
$340.12
|
| Rate for Payer: Quartz Commercial |
$440.61
|
| Rate for Payer: The Alliance Commercial |
$386.50
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$572.56
|
|
|
Ear Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Ear Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Ear Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
EAR DRESSING GLASSCOCK ADULT S-1000
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
3204818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
