|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,544.00
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$10,267.66 |
| Max. Negotiated Rate |
$28,544.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,267.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,238.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,045.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,194.68
|
| Rate for Payer: Anthem Medicare Advantage |
$10,267.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,267.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,267.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,267.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,977.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,267.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,701.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,267.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,267.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,267.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,267.66
|
| Rate for Payer: NAPHCARE Commercial |
$15,401.49
|
| Rate for Payer: Quartz Medicare Advantage |
$10,267.66
|
| Rate for Payer: The Alliance Commercial |
$28,544.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,267.66
|
| Rate for Payer: United Healthcare PPO |
$16,116.15
|
| Rate for Payer: Wellcare Medicare |
$10,267.66
|
|
|
Minor Dressing Change
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3026412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Minor Dressing Change
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3026412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$42,480.00
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$15,280.73 |
| Max. Negotiated Rate |
$42,480.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,280.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,358.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,568.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,292.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,280.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,280.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,280.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,280.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,280.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,923.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,280.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,280.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,280.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,280.73
|
| Rate for Payer: NAPHCARE Commercial |
$22,921.10
|
| Rate for Payer: Quartz Medicare Advantage |
$15,280.73
|
| Rate for Payer: The Alliance Commercial |
$42,480.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,280.73
|
| Rate for Payer: United Healthcare PPO |
$24,074.03
|
| Rate for Payer: Wellcare Medicare |
$15,280.73
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$24,075.00
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$8,660.07 |
| Max. Negotiated Rate |
$24,075.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,660.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,660.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,660.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,660.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,660.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,660.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,423.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,660.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,660.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,660.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,660.07
|
| Rate for Payer: NAPHCARE Commercial |
$12,990.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8,660.07
|
| Rate for Payer: The Alliance Commercial |
$24,075.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,660.07
|
| Rate for Payer: United Healthcare PPO |
$13,564.22
|
| Rate for Payer: Wellcare Medicare |
$8,660.07
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$41,279.00
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$14,848.47 |
| Max. Negotiated Rate |
$41,279.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,848.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,309.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,764.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,528.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,848.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,848.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,848.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,848.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,118.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,848.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,041.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,848.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,848.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,848.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,848.47
|
| Rate for Payer: NAPHCARE Commercial |
$22,272.70
|
| Rate for Payer: Quartz Medicare Advantage |
$14,848.47
|
| Rate for Payer: The Alliance Commercial |
$41,279.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,848.47
|
| Rate for Payer: United Healthcare PPO |
$23,387.85
|
| Rate for Payer: Wellcare Medicare |
$14,848.47
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,177.00
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$26,322.52 |
| Max. Negotiated Rate |
$73,177.00 |
| Rate for Payer: Wellcare Medicare |
$26,322.52
|
| Rate for Payer: Aetna Managed Medicare |
$26,322.52
|
| 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 |
$26,322.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,322.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,322.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,322.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,470.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,322.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,437.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,322.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,322.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,322.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,322.52
|
| Rate for Payer: NAPHCARE Commercial |
$39,483.78
|
| Rate for Payer: Quartz Medicare Advantage |
$26,322.52
|
| Rate for Payer: The Alliance Commercial |
$73,177.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,322.52
|
| Rate for Payer: United Healthcare PPO |
$41,602.01
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,558.00
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$12,430.87 |
| Max. Negotiated Rate |
$34,558.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,430.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,064.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,744.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,708.62
|
| Rate for Payer: Anthem Medicare Advantage |
$12,430.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,430.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,430.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,430.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,878.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,430.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,112.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,430.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,430.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,430.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,430.87
|
| Rate for Payer: NAPHCARE Commercial |
$18,646.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12,430.87
|
| Rate for Payer: The Alliance Commercial |
$34,558.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,430.87
|
| Rate for Payer: United Healthcare PPO |
$19,550.09
|
| Rate for Payer: Wellcare Medicare |
$12,430.87
|
|
|
MIRCO SHEATH 5F ACCESS KIT MAK501N-E
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6207078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
MIRCO SHEATH 5F ACCESS KIT MAK501N-E
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6207078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
MIRCO SHEATH 5F WITH NITNOL WIRE MR190521
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6207054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$261.28 |
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$244.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$150.52
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$261.28
|
| Rate for Payer: Health EOS Commercial |
$252.76
|
| Rate for Payer: HFN Commercial |
$261.28
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: NAPHCARE Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$261.28
|
| Rate for Payer: Quartz Beloit One Network |
$139.16
|
| Rate for Payer: Quartz Commercial |
$170.40
|
| Rate for Payer: WEA Trust Commercial |
$156.20
|
| Rate for Payer: WPS Commercial |
$210.36
|
|
|
MIRCO SHEATH 5F WITH NITNOL WIRE MR190521
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6207054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.52 |
| Max. Negotiated Rate |
$1,136.00 |
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$244.24
|
| Rate for Payer: Aetna Managed Medicare |
$79.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$184.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$150.52
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$261.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.93
|
| Rate for Payer: Health EOS Commercial |
$252.76
|
| Rate for Payer: HFN Commercial |
$261.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: NAPHCARE Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$261.28
|
| Rate for Payer: Quartz Beloit One Network |
$139.16
|
| Rate for Payer: Quartz Commercial |
$184.60
|
| Rate for Payer: Quartz Medicare Advantage |
$170.40
|
| Rate for Payer: The Alliance Commercial |
$1,136.00
|
| Rate for Payer: WEA Trust Commercial |
$156.20
|
| Rate for Payer: WPS Commercial |
$210.36
|
|
|
Mirena 1 unit Charge
|
Professional
|
Both
|
$2,362.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
2958942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$999.28 |
| Max. Negotiated Rate |
$2,243.90 |
| Rate for Payer: Aetna Commercial |
$2,243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,031.32
|
| Rate for Payer: Anthem Commercial |
$999.28
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,243.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,156.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,417.20
|
| Rate for Payer: Health EOS Commercial |
$2,149.42
|
| Rate for Payer: HFN Commercial |
$2,243.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,495.42
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.28
|
| Rate for Payer: Quartz Commercial |
$1,346.34
|
| Rate for Payer: The Alliance Commercial |
$1,181.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,156.79
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: WPS Commercial |
$1,749.53
|
|
|
Mirena 1 unit Charge
|
Facility
|
IP
|
$2,362.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
2958942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,157.38 |
| Max. Negotiated Rate |
$2,173.04 |
| Rate for Payer: Aetna Commercial |
$2,125.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,031.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.86
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,173.04
|
| Rate for Payer: Health EOS Commercial |
$2,102.18
|
| Rate for Payer: HFN Commercial |
$2,173.04
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,417.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,157.38
|
| Rate for Payer: Quartz Commercial |
$1,417.20
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: WPS Commercial |
$1,749.53
|
|
|
Mirena 1 unit Charge
|
Facility
|
OP
|
$2,362.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
2958942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$661.36 |
| Max. Negotiated Rate |
$9,448.00 |
| Rate for Payer: Aetna Commercial |
$2,125.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,031.32
|
| Rate for Payer: Aetna Managed Medicare |
$661.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,535.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,181.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,133.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.86
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,173.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,321.78
|
| Rate for Payer: Health EOS Commercial |
$2,102.18
|
| Rate for Payer: HFN Commercial |
$2,173.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,771.50
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,417.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,157.38
|
| Rate for Payer: Quartz Commercial |
$1,535.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,417.20
|
| Rate for Payer: The Alliance Commercial |
$9,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: WPS Commercial |
$1,749.53
|
|
|
Mirtazapine (Remeron)
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Mirtazapine (Remeron)
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Aetna Managed Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.92
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$130.00
|
| Rate for Payer: Quartz Medicare Advantage |
$120.00
|
| Rate for Payer: The Alliance Commercial |
$800.00
|
| Rate for Payer: United Healthcare PPO |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Mirtazapine (Remeron)
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: HFN Commercial |
$190.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$35,286.00
|
|
|
Service Code
|
MSDRG 640
|
| Min. Negotiated Rate |
$12,692.91 |
| Max. Negotiated Rate |
$35,286.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,692.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,693.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,226.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,166.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,692.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,692.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,692.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,692.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,387.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,692.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,646.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,692.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,692.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,692.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,692.91
|
| Rate for Payer: NAPHCARE Commercial |
$19,039.36
|
| Rate for Payer: Quartz Medicare Advantage |
$12,692.91
|
| Rate for Payer: The Alliance Commercial |
$35,286.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,692.91
|
| Rate for Payer: United Healthcare PPO |
$19,966.05
|
| Rate for Payer: Wellcare Medicare |
$12,692.91
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$21,095.00
|
|
|
Service Code
|
MSDRG 641
|
| Min. Negotiated Rate |
$7,588.03 |
| Max. Negotiated Rate |
$21,095.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,588.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,364.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,543.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,916.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,588.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,588.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,588.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,588.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,228.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,588.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,237.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,588.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,588.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,588.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,588.03
|
| Rate for Payer: NAPHCARE Commercial |
$11,382.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,588.03
|
| Rate for Payer: The Alliance Commercial |
$21,095.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,588.03
|
| Rate for Payer: United Healthcare PPO |
$11,862.43
|
| Rate for Payer: Wellcare Medicare |
$7,588.03
|
|
|
Miscellaneous Staple Supply
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3004326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Miscellaneous Staple Supply
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3004326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Miscellaneous Suture Supply
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
3004336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Miscellaneous Suture Supply
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
3004336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
MISC IMPLANTS/SUPPLY
|
Facility
|
OP
|
$9,053.00
|
|
| Hospital Charge Code |
3075880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,534.84 |
| Max. Negotiated Rate |
$36,212.00 |
| Rate for Payer: Aetna Commercial |
$8,147.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,785.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,534.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,884.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,526.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,345.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,798.09
|
| Rate for Payer: Cash Price |
$2,715.90
|
| Rate for Payer: Cigna Commercial |
$8,328.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,066.06
|
| Rate for Payer: Health EOS Commercial |
$8,057.17
|
| Rate for Payer: HFN Commercial |
$8,328.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,789.75
|
| Rate for Payer: Multiplan Commercial |
$7,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,431.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,328.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,435.97
|
| Rate for Payer: Quartz Commercial |
$5,884.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.80
|
| Rate for Payer: The Alliance Commercial |
$36,212.00
|
| Rate for Payer: WEA Trust Commercial |
$4,979.15
|
| Rate for Payer: WPS Commercial |
$6,705.56
|
|
