|
Magnesium Level
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Magnesium Level
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$127.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.40
|
| Rate for Payer: Health EOS Commercial |
$121.94
|
| Rate for Payer: HFN Commercial |
$127.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Preferred Network Access Commercial |
$127.30
|
| Rate for Payer: Quartz Beloit One Network |
$58.96
|
| Rate for Payer: Quartz Commercial |
$76.38
|
| Rate for Payer: The Alliance Commercial |
$67.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Magnesium Level
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$100.50
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Magnesium Level 24 Hour Urine
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Magnesium Level 24 Hour Urine
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Magnesium Level 24 Hour Urine
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$25.48
|
| Rate for Payer: HFN Commercial |
$26.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.60
|
| Rate for Payer: Quartz Beloit One Network |
$12.32
|
| Rate for Payer: Quartz Commercial |
$15.96
|
| Rate for Payer: The Alliance Commercial |
$14.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.00
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Magnesium, RBC
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: HFN Commercial |
$82.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Magnesium, RBC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Magnesium, RBC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Magnesium, Urine
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Magnesium, Urine
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Magnesium, Urine
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$73,099.00
|
|
|
Service Code
|
MSDRG 654
|
| Min. Negotiated Rate |
$26,294.78 |
| Max. Negotiated Rate |
$73,099.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,294.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57,485.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44,061.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,861.72
|
| Rate for Payer: Anthem Medicare Advantage |
$26,294.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,294.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,294.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,294.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,470.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,294.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,381.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,294.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,294.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,294.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,294.78
|
| Rate for Payer: NAPHCARE Commercial |
$39,442.17
|
| Rate for Payer: Quartz Medicare Advantage |
$26,294.78
|
| Rate for Payer: The Alliance Commercial |
$73,099.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,294.78
|
| Rate for Payer: United Healthcare PPO |
$41,557.99
|
| Rate for Payer: Wellcare Medicare |
$26,294.78
|
|
|
MAJOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$144,246.00
|
|
|
Service Code
|
MSDRG 653
|
| Min. Negotiated Rate |
$51,887.11 |
| Max. Negotiated Rate |
$144,246.00 |
| Rate for Payer: Quartz Medicare Advantage |
$51,887.11
|
| Rate for Payer: The Alliance Commercial |
$144,246.00
|
| Rate for Payer: Aetna Managed Medicare |
$51,887.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113,501.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86,998.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82,653.98
|
| Rate for Payer: Anthem Medicare Advantage |
$51,887.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51,887.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51,887.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51,887.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91,753.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51,887.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105,565.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51,887.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51,887.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51,887.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51,887.11
|
| Rate for Payer: NAPHCARE Commercial |
$77,830.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51,887.11
|
| Rate for Payer: United Healthcare PPO |
$82,183.86
|
| Rate for Payer: Wellcare Medicare |
$51,887.11
|
|
|
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$56,358.00
|
|
|
Service Code
|
MSDRG 655
|
| Min. Negotiated Rate |
$20,272.78 |
| Max. Negotiated Rate |
$56,358.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,272.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,930.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,236.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20,272.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,272.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,272.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,272.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,785.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,272.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,102.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,272.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,272.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,272.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,272.78
|
| Rate for Payer: NAPHCARE Commercial |
$30,409.17
|
| Rate for Payer: Quartz Medicare Advantage |
$20,272.78
|
| Rate for Payer: The Alliance Commercial |
$56,358.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,272.78
|
| Rate for Payer: United Healthcare PPO |
$31,998.51
|
| Rate for Payer: Wellcare Medicare |
$20,272.78
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$68,125.00
|
|
|
Service Code
|
MSDRG 164
|
| Min. Negotiated Rate |
$24,505.49 |
| Max. Negotiated Rate |
$68,125.00 |
| Rate for Payer: Aetna Managed Medicare |
$24,505.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,499.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,006.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,958.90
|
| Rate for Payer: Anthem Medicare Advantage |
$24,505.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,505.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,505.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,505.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,247.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,505.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,732.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,505.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,505.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,505.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,505.49
|
| Rate for Payer: NAPHCARE Commercial |
$36,758.24
|
| Rate for Payer: Quartz Medicare Advantage |
$24,505.49
|
| Rate for Payer: The Alliance Commercial |
$68,125.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,505.49
|
| Rate for Payer: United Healthcare PPO |
$38,717.62
|
| Rate for Payer: Wellcare Medicare |
$24,505.49
|
|
|
MAJOR CHEST PROCEDURES WITH MCC
|
Facility
|
IP
|
$125,636.00
|
|
|
Service Code
|
MSDRG 163
|
| Min. Negotiated Rate |
$45,192.80 |
| Max. Negotiated Rate |
$125,636.00 |
| Rate for Payer: Aetna Managed Medicare |
$45,192.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98,815.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75,741.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71,959.38
|
| Rate for Payer: Anthem Medicare Advantage |
$45,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45,192.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$45,192.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79,881.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$45,192.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91,915.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45,192.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45,192.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$45,192.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$45,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$67,789.20
|
| Rate for Payer: Quartz Medicare Advantage |
$45,192.80
|
| Rate for Payer: The Alliance Commercial |
$125,636.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45,192.80
|
| Rate for Payer: United Healthcare PPO |
$71,557.16
|
| Rate for Payer: Wellcare Medicare |
$45,192.80
|
|
|
MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$50,206.00
|
|
|
Service Code
|
MSDRG 165
|
| Min. Negotiated Rate |
$18,059.82 |
| Max. Negotiated Rate |
$50,206.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,059.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,059.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,059.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,059.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,059.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,059.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,589.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,059.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,059.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,059.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,059.82
|
| Rate for Payer: NAPHCARE Commercial |
$27,089.73
|
| Rate for Payer: Quartz Medicare Advantage |
$18,059.82
|
| Rate for Payer: The Alliance Commercial |
$50,206.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,059.82
|
| Rate for Payer: United Healthcare PPO |
$28,485.63
|
| Rate for Payer: Wellcare Medicare |
$18,059.82
|
|
|
MAJOR CHEST TRAUMA WITH CC
|
Facility
|
IP
|
$28,286.00
|
|
|
Service Code
|
MSDRG 184
|
| Min. Negotiated Rate |
$10,174.90 |
| Max. Negotiated Rate |
$28,286.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,174.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,029.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,885.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,041.90
|
| Rate for Payer: Anthem Medicare Advantage |
$10,174.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,174.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,174.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,174.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,807.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,174.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,512.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,174.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,174.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,174.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,174.90
|
| Rate for Payer: NAPHCARE Commercial |
$15,262.35
|
| Rate for Payer: Quartz Medicare Advantage |
$10,174.90
|
| Rate for Payer: The Alliance Commercial |
$28,286.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,174.90
|
| Rate for Payer: United Healthcare PPO |
$15,968.89
|
| Rate for Payer: Wellcare Medicare |
$10,174.90
|
|
|
MAJOR CHEST TRAUMA WITH MCC
|
Facility
|
IP
|
$42,180.00
|
|
|
Service Code
|
MSDRG 183
|
| Min. Negotiated Rate |
$15,172.67 |
| Max. Negotiated Rate |
$42,180.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,172.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,938.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,247.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,986.46
|
| Rate for Payer: Anthem Medicare Advantage |
$15,172.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,172.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,172.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,172.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,627.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,172.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,702.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,172.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,172.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,172.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,172.67
|
| Rate for Payer: NAPHCARE Commercial |
$22,759.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15,172.67
|
| Rate for Payer: The Alliance Commercial |
$42,180.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,172.67
|
| Rate for Payer: United Healthcare PPO |
$23,902.48
|
| Rate for Payer: Wellcare Medicare |
$15,172.67
|
|
|
MAJOR CHEST TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$20,411.00
|
|
|
Service Code
|
MSDRG 185
|
| Min. Negotiated Rate |
$7,342.24 |
| Max. Negotiated Rate |
$20,411.00 |
| Rate for Payer: NAPHCARE Commercial |
$11,013.36
|
| Rate for Payer: Quartz Medicare Advantage |
$7,342.24
|
| Rate for Payer: The Alliance Commercial |
$20,411.00
|
| Rate for Payer: Aetna Managed Medicare |
$7,342.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,221.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,611.28
|
| Rate for Payer: Anthem Medicare Advantage |
$7,342.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,342.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,342.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,342.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,889.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,342.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,736.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,342.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,342.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,342.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,342.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,342.24
|
| Rate for Payer: United Healthcare PPO |
$11,472.28
|
| Rate for Payer: Wellcare Medicare |
$7,342.24
|
|
|
Major Dressing Change
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3026414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
