|
PAIN
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00663
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
Pain Management Profile 1, Urine
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5358629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$287.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$287.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$275.40
|
| Rate for Payer: HFN Commercial |
$287.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$287.51
|
| Rate for Payer: Quartz Beloit One Network |
$133.16
|
| Rate for Payer: Quartz Commercial |
$172.50
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$255.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Pain Management Profile 1, Urine
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5358629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: United Healthcare PPO |
$226.98
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Pain Management Profile 1, Urine
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5358629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
*** PAIN PUMP 275ML 4ML FIXED RATE MC0040LYK5-CP*** DISC ***
|
Facility
|
OP
|
$2,844.00
|
|
| Hospital Charge Code |
2965273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.17 |
| Max. Negotiated Rate |
$2,721.14 |
| Rate for Payer: Aetna Commercial |
$2,661.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Aetna Managed Medicare |
$828.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,922.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,478.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,419.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.61
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,721.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,655.21
|
| Rate for Payer: Health EOS Commercial |
$2,632.41
|
| Rate for Payer: HFN Commercial |
$2,721.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,218.32
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,774.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.30
|
| Rate for Payer: Quartz Commercial |
$1,922.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,774.66
|
| Rate for Payer: The Alliance Commercial |
$1,478.88
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
*** PAIN PUMP 275ML 4ML FIXED RATE MC0040LYK5-CP*** DISC ***
|
Facility
|
IP
|
$2,844.00
|
|
| Hospital Charge Code |
2965273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,449.30 |
| Max. Negotiated Rate |
$2,721.14 |
| Rate for Payer: Aetna Commercial |
$2,661.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.61
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,721.14
|
| Rate for Payer: Health EOS Commercial |
$2,632.41
|
| Rate for Payer: HFN Commercial |
$2,721.14
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.30
|
| Rate for Payer: Quartz Commercial |
$1,774.66
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
PAIN PUMP 275ML 4ML FIXED RATE WITH 2ML BOLUS WITH 60 MIN RELOAD MT4060LYK5-CP
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
5577698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.10 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$559.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,297.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.60
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.08
|
| Rate for Payer: The Alliance Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
PAIN PUMP 275ML 4ML FIXED RATE WITH 2ML BOLUS WITH 60 MIN RELOAD MT4060LYK5-CP
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
5577698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
PAIRED HELICAL 2.4FR X 120CM 3 WIRE M0063303060
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
4520071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Aetna Managed Medicare |
$774.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,327.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.12
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,074.80
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,659.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,798.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,659.84
|
| Rate for Payer: The Alliance Commercial |
$1,383.20
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
PAIRED HELICAL 2.4FR X 120CM 3 WIRE M0063303060
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
4520071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.54 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,659.84
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
PALATOPLASTY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
PALATOPLASTY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Paliperidone Level
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5613543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$376.43 |
| Rate for Payer: Aetna Commercial |
$376.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$376.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$360.58
|
| Rate for Payer: HFN Commercial |
$376.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$376.43
|
| Rate for Payer: Quartz Beloit One Network |
$174.35
|
| Rate for Payer: Quartz Commercial |
$225.86
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Paliperidone Level
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5613543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$364.54 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$257.56
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$297.18
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
Paliperidone Level
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5613543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.16 |
| Max. Negotiated Rate |
$364.54 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$237.74
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
pANCA IgG
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2778806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$172.38
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$198.90
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
pANCA IgG
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2778806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
pANCA IgG
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2778806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.56
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
PANCREAS DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00635
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$80,168.40
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$22,717.08 |
| Max. Negotiated Rate |
$80,168.40 |
| Rate for Payer: Aetna Managed Medicare |
$22,717.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63,280.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,503.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,081.63
|
| Rate for Payer: Anthem Medicare Advantage |
$22,717.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,717.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,717.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,717.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,154.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,717.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,556.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,717.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,717.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,717.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,717.08
|
| Rate for Payer: NAPHCARE Commercial |
$34,075.63
|
| Rate for Payer: Quartz Medicare Advantage |
$22,717.08
|
| Rate for Payer: The Alliance Commercial |
$80,168.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,717.08
|
| Rate for Payer: United Healthcare PPO |
$45,586.96
|
| Rate for Payer: Wellcare Medicare |
$22,717.08
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$152,548.24
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$42,400.95 |
| Max. Negotiated Rate |
$152,548.24 |
| Rate for Payer: Aetna Managed Medicare |
$42,400.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119,361.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,489.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86,921.43
|
| Rate for Payer: Anthem Medicare Advantage |
$42,400.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,400.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,400.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,400.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96,490.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,400.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111,645.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,400.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,400.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,400.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,400.95
|
| Rate for Payer: NAPHCARE Commercial |
$63,601.42
|
| Rate for Payer: Quartz Medicare Advantage |
$42,400.95
|
| Rate for Payer: The Alliance Commercial |
$152,548.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,400.95
|
| Rate for Payer: United Healthcare PPO |
$86,917.42
|
| Rate for Payer: Wellcare Medicare |
$42,400.95
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$59,807.28
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$17,504.92 |
| Max. Negotiated Rate |
$59,807.28 |
| Rate for Payer: Aetna Managed Medicare |
$17,504.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,429.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,121.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,267.49
|
| Rate for Payer: Anthem Medicare Advantage |
$17,504.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,504.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,504.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,504.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,150.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,504.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,622.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,504.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,504.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,504.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,504.92
|
| Rate for Payer: NAPHCARE Commercial |
$26,257.37
|
| Rate for Payer: Quartz Medicare Advantage |
$17,504.92
|
| Rate for Payer: The Alliance Commercial |
$59,807.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,504.92
|
| Rate for Payer: United Healthcare PPO |
$33,960.50
|
| Rate for Payer: Wellcare Medicare |
$17,504.92
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$46,559.73
|
|
|
Service Code
|
APR-DRG 0061
|
| Min. Negotiated Rate |
$41,357.25 |
| Max. Negotiated Rate |
$46,559.73 |
| Rate for Payer: Anthem Medicaid |
$44,583.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44,583.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44,583.50
|
| Rate for Payer: Dean Health Medicaid |
$44,583.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,357.25
|
| Rate for Payer: Managed Health Services Medicaid |
$46,559.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$44,583.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44,583.50
|
| Rate for Payer: United Healthcare Medicaid |
$44,583.50
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$133,426.80
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$48,778.01 |
| Max. Negotiated Rate |
$133,426.80 |
| Rate for Payer: Aetna Managed Medicare |
$55,459.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66,982.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,341.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,778.01
|
| Rate for Payer: Anthem Medicare Advantage |
$55,459.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55,459.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55,459.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$55,459.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,148.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$55,459.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55,459.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55,459.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$55,459.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$55,459.71
|
| Rate for Payer: NAPHCARE Commercial |
$83,189.56
|
| Rate for Payer: Quartz Medicare Advantage |
$55,459.71
|
| Rate for Payer: The Alliance Commercial |
$133,426.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55,459.71
|
| Rate for Payer: Wellcare Medicare |
$55,459.71
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$77,687.23
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$69,006.64 |
| Max. Negotiated Rate |
$77,687.23 |
| Rate for Payer: Anthem Medicaid |
$74,389.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$74,389.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74,389.80
|
| Rate for Payer: Dean Health Medicaid |
$74,389.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$69,006.64
|
| Rate for Payer: Managed Health Services Medicaid |
$77,687.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$74,389.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$74,389.80
|
| Rate for Payer: United Healthcare Medicaid |
$74,389.80
|
|
