|
Acute Hepatitis Panel
|
Professional
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$47.63
|
| Rate for Payer: Anthem Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.63
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.63
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: Quartz Medicare Advantage |
$47.63
|
| Rate for Payer: The Alliance Commercial |
$188.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$209.57
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
IP
|
$59,753.00
|
|
|
Service Code
|
MS-DRG 835
|
| Min. Negotiated Rate |
$21,494.01 |
| Max. Negotiated Rate |
$59,753.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,494.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,995.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,021.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,222.72
|
| Rate for Payer: Anthem Medicare Advantage |
$21,494.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,494.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,494.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,494.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,990.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,494.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,592.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,494.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,494.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,494.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,494.01
|
| Rate for Payer: NAPHCARE Commercial |
$32,241.02
|
| Rate for Payer: Quartz Medicare Advantage |
$21,494.01
|
| Rate for Payer: The Alliance Commercial |
$59,753.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,494.01
|
| Rate for Payer: United Healthcare PPO |
$33,937.13
|
| Rate for Payer: Wellcare Medicare |
$21,494.01
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$149,175.00
|
|
|
Service Code
|
MS-DRG 834
|
| Min. Negotiated Rate |
$53,660.15 |
| Max. Negotiated Rate |
$149,175.00 |
| Rate for Payer: Aetna Managed Medicare |
$53,660.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117,488.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90,053.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85,556.80
|
| Rate for Payer: Anthem Medicare Advantage |
$53,660.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53,660.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53,660.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53,660.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94,975.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53,660.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109,180.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53,660.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53,660.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53,660.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53,660.15
|
| Rate for Payer: NAPHCARE Commercial |
$80,490.22
|
| Rate for Payer: Quartz Medicare Advantage |
$53,660.15
|
| Rate for Payer: The Alliance Commercial |
$149,175.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53,660.15
|
| Rate for Payer: United Healthcare PPO |
$84,998.42
|
| Rate for Payer: Wellcare Medicare |
$53,660.15
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$37,857.00
|
|
|
Service Code
|
MS-DRG 836
|
| Min. Negotiated Rate |
$13,617.67 |
| Max. Negotiated Rate |
$37,857.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,617.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13,617.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,617.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,617.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,617.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,617.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,347.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,617.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,617.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,617.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,617.67
|
| Rate for Payer: NAPHCARE Commercial |
$20,426.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13,617.67
|
| Rate for Payer: The Alliance Commercial |
$37,857.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,617.67
|
| Rate for Payer: United Healthcare PPO |
$18,176.21
|
| Rate for Payer: Wellcare Medicare |
$13,617.67
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$34,382.00
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$12,367.76 |
| Max. Negotiated Rate |
$34,382.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,367.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,367.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,367.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,367.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,367.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,367.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,983.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,367.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,367.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,367.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,367.76
|
| Rate for Payer: NAPHCARE Commercial |
$18,551.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12,367.76
|
| Rate for Payer: The Alliance Commercial |
$34,382.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,367.76
|
| Rate for Payer: United Healthcare PPO |
$19,449.90
|
| Rate for Payer: Wellcare Medicare |
$12,367.76
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$20,114.00
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$7,235.14 |
| Max. Negotiated Rate |
$20,114.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,235.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,235.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,235.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,235.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,517.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,235.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,235.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,235.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,235.14
|
| Rate for Payer: NAPHCARE Commercial |
$10,852.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,235.14
|
| Rate for Payer: The Alliance Commercial |
$20,114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,235.14
|
| Rate for Payer: United Healthcare PPO |
$11,302.25
|
| Rate for Payer: Wellcare Medicare |
$7,235.14
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
IP
|
$24,593.00
|
|
|
Service Code
|
MS-DRG 281
|
| Min. Negotiated Rate |
$8,846.56 |
| Max. Negotiated Rate |
$24,593.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,846.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,846.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,846.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,846.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,846.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,846.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,803.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,846.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,846.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,846.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,846.56
|
| Rate for Payer: NAPHCARE Commercial |
$13,269.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,846.56
|
| Rate for Payer: The Alliance Commercial |
$24,593.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,846.56
|
| Rate for Payer: United Healthcare PPO |
$13,860.25
|
| Rate for Payer: Wellcare Medicare |
$8,846.56
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
IP
|
$42,499.00
|
|
|
Service Code
|
MS-DRG 280
|
| Min. Negotiated Rate |
$15,287.44 |
| Max. Negotiated Rate |
$42,499.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,287.44
|
| 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 |
$15,287.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,287.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,287.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,287.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,287.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,936.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,287.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,287.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,287.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,287.44
|
| Rate for Payer: NAPHCARE Commercial |
$22,931.16
|
| Rate for Payer: Quartz Medicare Advantage |
$15,287.44
|
| Rate for Payer: The Alliance Commercial |
$42,499.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,287.44
|
| Rate for Payer: United Healthcare PPO |
$24,084.66
|
| Rate for Payer: Wellcare Medicare |
$15,287.44
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
IP
|
$19,412.00
|
|
|
Service Code
|
MS-DRG 282
|
| Min. Negotiated Rate |
$6,982.66 |
| Max. Negotiated Rate |
$19,412.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,982.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,105.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,578.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,000.16
|
| Rate for Payer: Anthem Medicare Advantage |
$6,982.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,982.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,982.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,982.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,211.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,982.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,002.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,982.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,982.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,982.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,982.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,473.99
|
| Rate for Payer: Quartz Medicare Advantage |
$6,982.66
|
| Rate for Payer: The Alliance Commercial |
$19,412.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,982.66
|
| Rate for Payer: United Healthcare PPO |
$10,901.48
|
| Rate for Payer: Wellcare Medicare |
$6,982.66
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
IP
|
$19,986.00
|
|
|
Service Code
|
MS-DRG 284
|
| Min. Negotiated Rate |
$7,189.25 |
| Max. Negotiated Rate |
$19,986.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,189.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,189.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,189.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,189.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,424.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,189.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,189.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,189.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,189.25
|
| Rate for Payer: NAPHCARE Commercial |
$10,783.88
|
| Rate for Payer: Quartz Medicare Advantage |
$7,189.25
|
| Rate for Payer: The Alliance Commercial |
$19,986.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,189.25
|
| Rate for Payer: United Healthcare PPO |
$11,229.39
|
| Rate for Payer: Wellcare Medicare |
$7,189.25
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
IP
|
$52,732.00
|
|
|
Service Code
|
MS-DRG 283
|
| Min. Negotiated Rate |
$18,968.34 |
| Max. Negotiated Rate |
$52,732.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,968.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,330.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,679.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,097.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18,968.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,968.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,968.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,968.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,411.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,968.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,442.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,968.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,968.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,968.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,968.34
|
| Rate for Payer: NAPHCARE Commercial |
$28,452.51
|
| Rate for Payer: Quartz Medicare Advantage |
$18,968.34
|
| Rate for Payer: The Alliance Commercial |
$52,732.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,968.34
|
| Rate for Payer: United Healthcare PPO |
$29,927.82
|
| Rate for Payer: Wellcare Medicare |
$18,968.34
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
IP
|
$13,313.00
|
|
|
Service Code
|
MS-DRG 285
|
| Min. Negotiated Rate |
$4,788.85 |
| Max. Negotiated Rate |
$13,313.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,788.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,280.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,879.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,486.22
|
| Rate for Payer: Anthem Medicare Advantage |
$4,788.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,788.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,788.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,788.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,310.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,788.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,529.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,788.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,788.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,788.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,788.85
|
| Rate for Payer: NAPHCARE Commercial |
$7,183.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4,788.85
|
| Rate for Payer: The Alliance Commercial |
$13,313.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,788.85
|
| Rate for Payer: United Healthcare PPO |
$7,418.95
|
| Rate for Payer: Wellcare Medicare |
$4,788.85
|
|
|
Acute Peritoneal Dialysis
|
Facility
OP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$665.84 |
| Max. Negotiated Rate |
$9,512.00 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Aetna Managed Medicare |
$665.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,545.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,330.73
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.50
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,545.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,426.80
|
| Rate for Payer: The Alliance Commercial |
$9,512.00
|
| Rate for Payer: United Healthcare PPO |
$1,783.50
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
Acute Peritoneal Dialysis
|
Facility
IP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$1,165.22 |
| Max. Negotiated Rate |
$2,187.76 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,426.80
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
Acylcarnitines Quantitative
|
Facility
IP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Acylcarnitines Quantitative
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Acylcarnitines Quantitative
|
Professional
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$74.23
|
|
|
Adalimumab ADA
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$1,112.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$1,112.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab ADA
|
Professional
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$264.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$252.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Preferred Network Access Commercial |
$264.10
|
| Rate for Payer: Quartz Beloit One Network |
$122.32
|
| Rate for Payer: Quartz Commercial |
$158.46
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Adalimumab ADA
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$1,112.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$1,112.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Professional
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$264.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$252.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Preferred Network Access Commercial |
$264.10
|
| Rate for Payer: Quartz Beloit One Network |
$122.32
|
| Rate for Payer: Quartz Commercial |
$158.46
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$30.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.23
|
| Rate for Payer: Anthem Medicaid |
$31.89
|
| Rate for Payer: Anthem Medicare Advantage |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.86
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.89
|
| Rate for Payer: Dean Health Medicaid |
$31.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.86
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.86
|
| Rate for Payer: Managed Health Services Medicaid |
$33.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$46.29
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31.89
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$30.86
|
| Rate for Payer: The Alliance Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.86
|
| Rate for Payer: United Healthcare PPO |
$292.50
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: Wellcare Medicare |
$30.86
|
| Rate for Payer: WMAP Medicaid |
$31.89
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
