|
Chemo IV Infusion 1 Hour
|
Facility
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
4618619
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$334.74 |
| Max. Negotiated Rate |
$1,245.23 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare PPO |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
Chemo IV Infusion 1 Hour
|
Facility
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
4618619
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
Chemo IV Infusion Additional 1-8 Hours
|
Facility
IP
|
$398.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
4618620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.02 |
| Max. Negotiated Rate |
$366.16 |
| Rate for Payer: Aetna Commercial |
$358.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.94
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$366.16
|
| Rate for Payer: Health EOS Commercial |
$354.22
|
| Rate for Payer: HFN Commercial |
$366.16
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: NAPHCARE Commercial |
$238.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.16
|
| Rate for Payer: Quartz Beloit One Network |
$195.02
|
| Rate for Payer: Quartz Commercial |
$238.80
|
| Rate for Payer: WEA Trust Commercial |
$218.90
|
| Rate for Payer: WPS Commercial |
$294.80
|
|
|
Chemo IV Infusion Additional 1-8 Hours
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
4618620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$366.16 |
| Rate for Payer: Aetna Commercial |
$358.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.04
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$366.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$354.22
|
| Rate for Payer: HFN Commercial |
$366.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$366.16
|
| Rate for Payer: Quartz Beloit One Network |
$195.02
|
| Rate for Payer: Quartz Commercial |
$258.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$298.50
|
| Rate for Payer: WEA Trust Commercial |
$218.90
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$294.80
|
|
|
Chemo, IV Push, Addl Drug 96411
|
Facility
IP
|
$503.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3595514
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
Chemo, IV Push, Addl Drug 96411
|
Facility
OP
|
$503.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3595514
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$377.25
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
OP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$334.56 |
| Max. Negotiated Rate |
$1,245.23 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.56
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$453.05
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare PPO |
$522.75
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
IP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$341.53 |
| Max. Negotiated Rate |
$641.24 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$418.20
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$418.20
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
CHEMO PORT INSERTION
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CHEMO PORT INSERTION
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Chemotherapy Infusion > 8 hrs per portable pump
|
Facility
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
5220607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$334.74 |
| Max. Negotiated Rate |
$1,378.16 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.28
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.04
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$973.70
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
Chemotherapy Infusion > 8 hrs per portable pump
|
Facility
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
5220607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$734.02 |
| Max. Negotiated Rate |
$1,378.16 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$898.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$898.80
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
Chemotherapy Infusion ea addl seq up to 1 hr
|
Facility
IP
|
$633.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
5216617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$310.17 |
| Max. Negotiated Rate |
$582.36 |
| Rate for Payer: Aetna Commercial |
$569.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.49
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$582.36
|
| Rate for Payer: Health EOS Commercial |
$563.37
|
| Rate for Payer: HFN Commercial |
$582.36
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: NAPHCARE Commercial |
$379.80
|
| Rate for Payer: Preferred Network Access Commercial |
$582.36
|
| Rate for Payer: Quartz Beloit One Network |
$310.17
|
| Rate for Payer: Quartz Commercial |
$379.80
|
| Rate for Payer: WEA Trust Commercial |
$348.15
|
| Rate for Payer: WPS Commercial |
$468.86
|
|
|
Chemotherapy Infusion ea addl seq up to 1 hr
|
Facility
OP
|
$633.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
5216617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$582.36 |
| Rate for Payer: Aetna Commercial |
$569.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.38
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$411.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$316.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$303.84
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$582.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$563.37
|
| Rate for Payer: HFN Commercial |
$582.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$582.36
|
| Rate for Payer: Quartz Beloit One Network |
$310.17
|
| Rate for Payer: Quartz Commercial |
$411.45
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: WEA Trust Commercial |
$348.15
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$468.86
|
|
|
CHEMOTHERAPY, INTO CNS 96450
|
Professional
|
$783.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
3015505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$743.85 |
| Rate for Payer: Aetna Commercial |
$743.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Aetna Managed Medicare |
$72.65
|
| Rate for Payer: Anthem Medicare Advantage |
$72.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.65
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$743.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.65
|
| Rate for Payer: Health EOS Commercial |
$712.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$607.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.65
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$743.85
|
| Rate for Payer: Quartz Beloit One Network |
$344.52
|
| Rate for Payer: Quartz Commercial |
$446.31
|
| Rate for Payer: Quartz Medicare Advantage |
$72.65
|
| Rate for Payer: The Alliance Commercial |
$181.62
|
| Rate for Payer: United Healthcare Medicaid |
$131.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.65
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$290.60
|
|
|
CHEMOTHERAPY, INTRACAVITARY 96440
|
Professional
|
$820.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
3015504
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.41 |
| Max. Negotiated Rate |
$3,288.41 |
| Rate for Payer: Aetna Commercial |
$779.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$705.20
|
| Rate for Payer: Aetna Managed Medicare |
$127.41
|
| Rate for Payer: Anthem Medicare Advantage |
$127.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.41
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$779.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.41
|
| Rate for Payer: Health EOS Commercial |
$746.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,288.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.41
|
| Rate for Payer: Multiplan Commercial |
$656.00
|
| Rate for Payer: Preferred Network Access Commercial |
$779.00
|
| Rate for Payer: Quartz Beloit One Network |
$360.80
|
| Rate for Payer: Quartz Commercial |
$467.40
|
| Rate for Payer: Quartz Medicare Advantage |
$127.41
|
| Rate for Payer: The Alliance Commercial |
$318.52
|
| Rate for Payer: United Healthcare Medicaid |
$131.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.41
|
| Rate for Payer: WEA Trust Commercial |
$451.00
|
| Rate for Payer: WPS Commercial |
$509.64
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
IP
|
$129,103.00
|
|
|
Service Code
|
MS-DRG 837
|
| Min. Negotiated Rate |
$46,439.87 |
| Max. Negotiated Rate |
$129,103.00 |
| Rate for Payer: NAPHCARE Commercial |
$69,659.80
|
| Rate for Payer: Aetna Managed Medicare |
$46,439.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99,864.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,545.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72,723.28
|
| Rate for Payer: Anthem Medicare Advantage |
$46,439.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,439.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,439.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,439.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80,729.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,439.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92,753.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,439.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,439.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,439.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,439.87
|
| Rate for Payer: Quartz Medicare Advantage |
$46,439.87
|
| Rate for Payer: The Alliance Commercial |
$129,103.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,439.87
|
| Rate for Payer: United Healthcare PPO |
$72,209.94
|
| Rate for Payer: Wellcare Medicare |
$46,439.87
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
IP
|
$53,538.00
|
|
|
Service Code
|
MS-DRG 838
|
| Min. Negotiated Rate |
$19,258.11 |
| Max. Negotiated Rate |
$53,538.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,258.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,911.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,357.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,792.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19,258.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,258.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,258.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,258.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,071.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,258.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,071.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,258.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,258.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,258.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,258.11
|
| Rate for Payer: NAPHCARE Commercial |
$28,887.16
|
| Rate for Payer: Quartz Medicare Advantage |
$19,258.11
|
| Rate for Payer: The Alliance Commercial |
$53,538.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,258.11
|
| Rate for Payer: United Healthcare PPO |
$29,639.38
|
| Rate for Payer: Wellcare Medicare |
$19,258.11
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$34,965.00
|
|
|
Service Code
|
MS-DRG 839
|
| Min. Negotiated Rate |
$12,577.20 |
| Max. Negotiated Rate |
$34,965.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,577.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,274.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,905.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,861.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12,577.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,577.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,577.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,577.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,047.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,577.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,410.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,577.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,577.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,577.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,577.20
|
| Rate for Payer: NAPHCARE Commercial |
$18,865.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12,577.20
|
| Rate for Payer: The Alliance Commercial |
$34,965.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,577.20
|
| Rate for Payer: United Healthcare PPO |
$19,782.36
|
| Rate for Payer: Wellcare Medicare |
$12,577.20
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
IP
|
$32,559.00
|
|
|
Service Code
|
MS-DRG 847
|
| Min. Negotiated Rate |
$11,711.71 |
| Max. Negotiated Rate |
$32,559.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,711.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,385.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,458.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,486.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11,711.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,711.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,711.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,711.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,521.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,711.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,645.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,711.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,711.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,711.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,711.71
|
| Rate for Payer: NAPHCARE Commercial |
$17,567.56
|
| Rate for Payer: Quartz Medicare Advantage |
$11,711.71
|
| Rate for Payer: The Alliance Commercial |
$32,559.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,711.71
|
| Rate for Payer: United Healthcare PPO |
$18,408.48
|
| Rate for Payer: Wellcare Medicare |
$11,711.71
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
IP
|
$65,296.00
|
|
|
Service Code
|
MS-DRG 846
|
| Min. Negotiated Rate |
$23,487.94 |
| Max. Negotiated Rate |
$65,296.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,487.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51,191.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,237.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,278.32
|
| Rate for Payer: Anthem Medicare Advantage |
$23,487.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,487.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,487.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,487.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,382.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,487.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,658.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,487.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,487.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,487.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,487.94
|
| Rate for Payer: NAPHCARE Commercial |
$35,231.91
|
| Rate for Payer: Quartz Medicare Advantage |
$23,487.94
|
| Rate for Payer: The Alliance Commercial |
$65,296.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,487.94
|
| Rate for Payer: United Healthcare PPO |
$37,102.36
|
| Rate for Payer: Wellcare Medicare |
$23,487.94
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$22,552.00
|
|
|
Service Code
|
MS-DRG 848
|
| Min. Negotiated Rate |
$8,112.09 |
| Max. Negotiated Rate |
$22,552.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,112.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,221.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,611.28
|
| Rate for Payer: Anthem Medicare Advantage |
$8,112.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,112.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,112.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,112.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,889.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,112.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,810.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,112.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,112.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,112.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,112.09
|
| Rate for Payer: NAPHCARE Commercial |
$12,168.14
|
| Rate for Payer: Quartz Medicare Advantage |
$8,112.09
|
| Rate for Payer: The Alliance Commercial |
$22,552.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,112.09
|
| Rate for Payer: United Healthcare PPO |
$11,529.97
|
| Rate for Payer: Wellcare Medicare |
$8,112.09
|
|
|
CHEST DRAIN ATRUIM EXPRESS ATS BLOOD RECOVERY 4050-100N
|
Facility
OP
|
$773.00
|
|
| Hospital Charge Code |
5179403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$3,092.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.78
|
| Rate for Payer: Aetna Managed Medicare |
$216.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$371.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.69
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$711.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.57
|
| Rate for Payer: Health EOS Commercial |
$687.97
|
| Rate for Payer: HFN Commercial |
$711.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.75
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: NAPHCARE Commercial |
$463.80
|
| Rate for Payer: Preferred Network Access Commercial |
$711.16
|
| Rate for Payer: Quartz Beloit One Network |
$378.77
|
| Rate for Payer: Quartz Commercial |
$502.45
|
| Rate for Payer: Quartz Medicare Advantage |
$463.80
|
| Rate for Payer: The Alliance Commercial |
$3,092.00
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$572.56
|
|
|
CHEST DRAIN ATRUIM EXPRESS ATS BLOOD RECOVERY 4050-100N
|
Facility
IP
|
$773.00
|
|
| Hospital Charge Code |
5179403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.77 |
| Max. Negotiated Rate |
$711.16 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.69
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$711.16
|
| Rate for Payer: Health EOS Commercial |
$687.97
|
| Rate for Payer: HFN Commercial |
$711.16
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: NAPHCARE Commercial |
$463.80
|
| Rate for Payer: Preferred Network Access Commercial |
$711.16
|
| Rate for Payer: Quartz Beloit One Network |
$378.77
|
| Rate for Payer: Quartz Commercial |
$463.80
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$572.56
|
|
|
CHEST DRAIN DUAL OASIS 3620-100
|
Facility
IP
|
$1,065.00
|
|
| Hospital Charge Code |
4020638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.85 |
| Max. Negotiated Rate |
$979.80 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$639.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
