|
Indwelling catheter latex A4338
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
3133582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Indwelling catheter special A4340
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A4340
|
| Hospital Charge Code |
3142829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$130.47 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$18.20
|
| Rate for Payer: HFN Commercial |
$19.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.47
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$8.80
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$10.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Indwelling catheter special A4340
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS A4340
|
| Hospital Charge Code |
3142829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.19
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Indwelling catheter special A4340
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS A4340
|
| Hospital Charge Code |
3142829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Indwelling/Continuous* - Urinary catheter type:
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877763
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous* - Urinary catheter type:
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877763
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous - Urinary Catheter Type
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999940
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous - Urinary Catheter Type
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999940
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510857
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510857
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Indwelling/Continuous with Urometer - Urinary Catheter Type
|
Facility
|
IP
|
$477.00
|
|
| Hospital Charge Code |
2999939
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$233.73 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$286.20
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$286.20
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Indwelling/Continuous with Urometer - Urinary Catheter Type
|
Facility
|
OP
|
$477.00
|
|
| Hospital Charge Code |
2999939
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$133.56 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$133.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$238.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.93
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.75
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$286.20
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$310.05
|
| Rate for Payer: Quartz Medicare Advantage |
$286.20
|
| Rate for Payer: The Alliance Commercial |
$1,908.00
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Infant Hearing Screening
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
1188824
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$63.60
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: United Healthcare PPO |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Infant Hearing Screening
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
1188824
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$26,710.00
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$9,607.80 |
| Max. Negotiated Rate |
$26,710.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,607.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,607.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,607.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,607.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,607.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,607.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,355.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,607.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,607.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,607.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,607.80
|
| Rate for Payer: NAPHCARE Commercial |
$14,411.70
|
| Rate for Payer: Quartz Medicare Advantage |
$9,607.80
|
| Rate for Payer: The Alliance Commercial |
$26,710.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,607.80
|
| Rate for Payer: United Healthcare PPO |
$15,068.66
|
| Rate for Payer: Wellcare Medicare |
$9,607.80
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$39,976.00
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$14,379.86 |
| Max. Negotiated Rate |
$39,976.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,379.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,260.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,960.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,764.22
|
| Rate for Payer: Anthem Medicare Advantage |
$14,379.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,379.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,379.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,379.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,379.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,086.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,379.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,379.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,379.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,379.86
|
| Rate for Payer: NAPHCARE Commercial |
$21,569.79
|
| Rate for Payer: Quartz Medicare Advantage |
$14,379.86
|
| Rate for Payer: The Alliance Commercial |
$39,976.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,379.86
|
| Rate for Payer: United Healthcare PPO |
$22,643.98
|
| Rate for Payer: Wellcare Medicare |
$14,379.86
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$6,295.07 |
| Max. Negotiated Rate |
$17,500.00 |
| Rate for Payer: Anthem Medicare Advantage |
$6,295.07
|
| Rate for Payer: Aetna Managed Medicare |
$6,295.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,637.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,452.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,930.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,295.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,295.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,295.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,023.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,295.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,600.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,295.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,295.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,295.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,295.07
|
| Rate for Payer: NAPHCARE Commercial |
$9,442.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,295.07
|
| Rate for Payer: The Alliance Commercial |
$17,500.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,295.07
|
| Rate for Payer: United Healthcare PPO |
$9,809.96
|
| Rate for Payer: Wellcare Medicare |
$6,295.07
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$16.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.47
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.55
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.55
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$24.82
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$16.55
|
| Rate for Payer: The Alliance Commercial |
$66.20
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare PPO |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.42
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3005542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
2600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3005542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.44
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
2600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.44
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.95
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$93.75
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$54,508.00
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$19,607.18 |
| Max. Negotiated Rate |
$54,508.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,607.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,799.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,805.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,167.12
|
| Rate for Payer: Anthem Medicare Advantage |
$19,607.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,607.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,607.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,607.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,598.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,607.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,744.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,607.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,607.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,607.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,607.18
|
| Rate for Payer: NAPHCARE Commercial |
$29,410.77
|
| Rate for Payer: Quartz Medicare Advantage |
$19,607.18
|
| Rate for Payer: The Alliance Commercial |
$54,508.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,607.18
|
| Rate for Payer: United Healthcare PPO |
$30,941.91
|
| Rate for Payer: Wellcare Medicare |
$19,607.18
|
|
